Clinical factors associated with growth and mortality of pediatric patients on HAART at Mulago PIDC, Uganda, 2003--2006

The global social and economic burden of HIV/AIDS is great, with over forty million people reported to be living with HIV/AIDS at the end of 2005; two million of these are children from birth to 15 years of age. Antiretroviral therapy has been shown to improve growth and survival of HIV-infected individuals. The purpose of this study is to describe a cohort of HIV-infected pediatric patients and assess the association between clinical factors, with growth and mortality outcomes. ^ This was a historical cohort study. Medical records of infants and children receiving HIV care at Mulago Pediatric Infectious Disease Clinic (PIDC) in Uganda between July 2003 and March 2006 were analyzed. Height and weight measurements were age and sex standardized to Centers for Disease Control and prevention (CDC) 2000 reference. Descriptive and logistic regression analyses were performed to identify covariates associated with risk of stunting or being underweight, and mortality. Longitudinal regression analysis with a mixed model using autoregressive covariance structure was used to compare change in height and weight before and after initiation of highly active antiretroviral therapy (HAART). ^ The study population was comprised of 1059 patients 0-20 years of age, the majority of whom were aged thirteen years and below (74.6%). Mean height-for-age before initiation of HAART was in the 10th percentile, mean weight-for-age was in the 8th percentile, and the mean weight-for-height was in the 23rd percentile. Initiation of HAART resulted in improvement in both the mean standardized weight-for-age Z score and weight-for-age percentiles (p <0.001). Baseline age, and weight-for-age Z score were associated with stunting (p <0.001). A negative weight-for-age Z score was associated with stunting (OR 4.60, CI 3.04-5.49). Risk of death decreased from 84% in the >2-8 years age category to 21% in the >13 years age category respectively, compared to the 0-2 years of age (p <0.05). ^ This pediatric population gained weight significantly more rapidly than height after starting HAART. A low weight-for-age Z score was associated with poor survival in children. These findings suggest that age, weight, and height measurements be monitored closely at Mulago PIDC. ^

The impact of functional impairment on the survival of patients with Alzheimer's disease

Alzheimer's disease (AD), the most common form of dementia, is the fifth leading cause of death among U.S. adults aged 65 or older. Most AD patients have shorter life expectancy compared with older people without dementia. This disease has become an enormous challenge in the aging society and is also a global problem. Not only do families of patients with Alzheimer's disease need to pay attention to this problem, but also the healthcare system and society as a whole have to confront. In dementia, functional impairment is associated with basic activities of daily living (ADL) and instrumental activities of daily living (IADL). For patients with Alzheimer's disease, problems typically appear in performing IADL and progress to the inability of managing less complex ADL functions of personal care. Thus, assessment of ADLs can be used for early accurate diagnosis of Alzheimer's disease. It should be useful for patients, caregivers, clinicians, and policy planners to estimate the survival of patients with Alzheimer's disease. However, it is unclear that when making predictions of patient outcome according to their histories, time-dependent covariates will provide us with important information on how changes in a patient's status can effect the survival. In this study, we examined the effect of impaired basic ADL as measured by the Physical Self-Maintenance Scale (PSMS) and utilized a multistate survival analysis approach to estimate the probability of death in the first few years of initial visit for AD patients taking into consideration the possibility of impaired basic ADL. The dataset used in this study was obtained from the Baylor Alzheimer's Disease and Memory Disorders Center (ADMDC). No impaired basic ADL and older age at onset of impaired basic ADL were associated with longer survival. These findings suggest that the occurrence of impaired basic ADL and age at impaired basic ADL could be predictors of survival among patients with Alzheimer's disease. ^

The Ryan White CARE Act : 20 years of transition

The Ryan White CARE Act has undergone substantial changes in the past 20 years. Today it serves over 500,000 persons living with HIV/AIDS in the United States. The purpose of this project was to update the history and content Ryan White CARE Act and to consider how changes since the 2006 CARE Act reauthorization have affected the Ryan White Planning Council in Harris County. The results of the 2008 Houston Area HIV/AIDS Needs Assessment were reviewed and compared to responses to access of service questions of the 2005 Houston Area HIV/AIDS Needs Assessment. The results of the comparison show that informational barriers continue to be the leading barriers in persons living with HIV/AIDS to accessing services. In conclusion the strength of the Ryan White CARE Act is its ability to respond to a changing epidemic and its weakness lies in its vulnerability to shifting political sentiments. ^

SOCIAL, ATTITUDINAL AND BEHAVIORAL CORRELATES OF WEIGHT CHANGE AMONG MEXICAN AMERICAN WOMEN (OBESITY, DIET, TEXAS)

In industrialized countries the prevalence of obesity among women decreases with increasing socioeconomic status. While this relation has been amply documented, its explanation and implications for other causal factors of obesity has received much less attention. Differences in childbearing patterns, norms and attitudes about fatness, dietary behaviors and physical activity are some of the factors that have been proposed to explain the inverse relation.^ The objectives of this investigation were to (1) examine the associations among social characteristics and weight-related attitudes and behaviors, and (2) examine the relations of these factors to weight change and obesity. Information on social characteristics, weight-related attitudes, dietary behaviors, physical activity and childbearing were collected from 304 Mexican American women aged 19 to 50 living in Starr County, Texas, who were at high risk for developing diabetes. Their weights were recorded both at an initial physical examination and at a follow-up interview one to two and one-half years later, permitting the computation of current Body Mass Index (weight/height('2)) and weight change during the interval for each subject. Path analysis was used to examine direct and indirect relations among the variables.^ The major findings were: (1) After controlling for age, childbearing was not an independent predictor of weight change or Body Mass Index. (2) Neither planned exercise nor total daily physical activity were independent predictors of weight change. (3) Women with higher social characteristics scores reported less frequent meals and less use of calorically dense foods, factors associated with lower risk for weight gain. (4) Dietary intake measures were not significantly related to Body Mass Index. However, dietary behaviors (frequency of meals and snacks, use of high and low caloric density foods, eating restraint and disinhibition of restraint) did explain a significant portion (17.4 percent) of the variance in weight change, indicating the importance of using dynamic measures of weight status in studies of the development of obesity. This study highlights factors amenable to intervention to reverse or to prevent weight gain in this population, and thereby reduce the prevalence of diabetes and its sequelae. ^

Factors influencing participation in individuals with disability: A secondary data analysis

Individuals with disabilities face numerous barriers to participation due to biological and physical characteristics of the disability as well as social and environmental factors. Participation can be impacted on all levels from societal, to activities of daily living, exercise, education, and interpersonal relationships. This study evaluated the impact of pain, mood, depression, quality of life and fatigue on participation for individuals with mobility impairments. This cross sectional study derives from self-report data collected from a wheelchair using sample. Bivariate correlational and multivariate analysis were employed to examine the relationship between pain, quality of life, positive and negative mood, fatigue, and depression with participation while controlling for relevant socio-demographic variables (sex, age, time with disability, race, and education). Results from the 122 respondents with mobility impairments demonstrated that after controlling for socio-demographic characteristics in the full model, 20% of the variance in participation scores were accounted for by pain, quality of life, positive and negative mood, and depression. Notably, quality of life emerged as being the single variable that was significantly related to participation in the full model. Contrary to other studies, pain did not appear to significantly impact participation outcomes for wheelchair users in this sample. Participation is an emerging area of interest among rehabilitation and disability researchers, and results of this study provide compelling evidence that several psychosocial factors are related to participation. This area of inquiry warrants further study, as many of the psychosocial variables identified in this study (mood, depression, quality of life) may be amenable to intervention, which may also positively influence participation.^

Knowledge and Attitudes of Young People in Nigeria about HIV/AIDS---A systematic review

Background: HIV/AIDS has remained one of Nigeria's biggest health and social issues for decades. People aged between 10 and 24 are the most affected. Research into why this population subset is affected is very pertinent. We therefore conducted a systematic review of the Knowledge and Attitudes of young people in Nigeria about HIV/AIDS to understand where the gaps between knowledge and attitudes can be bridged. ^ Methods: We conducted searches in Medline, PubMed, African Index Medicus, Cumulative Index of Nursing and Allied Health. WHO and UNAIDS documents were also searched. Other journals were hand searched. Searches were for studies between 1986 (when HIV/AIDS was first reported in Nigeria) till date. In addition, data abstraction and quality assessment were done. ^ Results: 279 titles and abstracts were found and 33 articles in full text were appraised critically and 17 articles were selected based on our criteria. This revealed a dearth of well conducted studies in the literature despite the enormity of the HIV/AIDS epidemic. Constructs for Knowledge and attitudes were itemized on two tables for each article based on the Health Belief Model. Even though many of the studies showed high level of knowledge about HIV/AIDS, it did not impact attitudes about the disease. Also fear and anxiety prevented participants from acquiring knowledge. These recurring themes arguably were not limited to any region or area, background or group. ^ Conclusion: There is a need for future research to be culturally sensitive with a focus on attitudes and correction of misconceptions about HIV/AIDS among our youth.^

WORKLOAD AND PERFORMANCE FACTORS ASSOCIATED WITH MULTIMEDIA JOB AIDS FOR COMMUNITY HEALTH WORKERS

This dissertation focuses on factors of multimedia job aids that modify workload, protocol adherence and clinical errors in community health workers. Literature shows that community health workers performance is not acceptable even with support of paper job aids. There are cognitive theories that try to explain reasons why the performance of community health workers is poor regardless of the access to paper based-job aid. Based on cognitive science and multimedia design theories an intervention was designed to compare alternative representations for the information contained on paper job aids and the capability of this new designed job aids to enhance community health workers performance. The dissertation is divided in 5 main parts: 1. identification and description of the problem, 2. a methodological approach to create and evaluate an intervention, 3. Presentation of results of the intervention evaluation, 4. Discussion of findings and 5. Conclusions

Back to the future to revisit meanings

Tanto en los estudios sincrónicos como en los diacrónicos queda en evidencia que el español posee diferentes formas de expresar el tiempo futuro. Por ejemplo, la desinencia del futuro morfológico (-ré) alterna en el español actual con la perífrasis verbal ir+a+infinitivo tal y como se ve en los siguientes ejemplos de la variedad rioplatense: (1) CFK advirtió que "Vamos a sostener este modelo de crecimiento con todas las decisiones que haya que tomar" (Diario Digital 25-04-2012); (2) Rossi aseguró que votarán a favor de YPF unos doscientos diputados (La Nación 28-04-2012). Este hecho ha sido analizado por innumerables estudios y autores, muchos de los cuales se han aproximado a este tema desde la perspectiva variacionista que relaciona significados y contextos (Martínez 1987, Sedano 1994, Company 1999, Alaniz 2010); esta perspectiva explica dicha alternancia por medio de un continuum de factualidad el cual va desde la mayor factualidad de la perífrasis a la menor factualidad de la forma sintética. El análisis de los datos de acuerdo con dichos significados básicos postulados parecía confirmar la hipótesis, al menos en los contextos relacionados con la comunicación oral cotidiana (Martínez 1987). Sin embargo, un estudio más profundo sobre los usos de dichas formas en otros géneros discursivos (Mailhes 2010) nos lleva a replantearnos los significados básicos. En este sentido, la hipótesis que nos interesa confirmar es que las formas se encuentran vinculadas a la evaluación de los hechos por medio de la posibilidad de ejercer control sobre los mismos . Si existe control, se puede seleccionar la perífrasis; si no existe, la forma sintética será más apropiada. La ausencia de control puede dar lugar a una posibilidad más o menos remota así como a la profecía, dos esferas donde la variación es explotada

Back to the future to revisit meanings

Tanto en los estudios sincrónicos como en los diacrónicos queda en evidencia que el español posee diferentes formas de expresar el tiempo futuro. Por ejemplo, la desinencia del futuro morfológico (-ré) alterna en el español actual con la perífrasis verbal ir+a+infinitivo tal y como se ve en los siguientes ejemplos de la variedad rioplatense: (1) CFK advirtió que "Vamos a sostener este modelo de crecimiento con todas las decisiones que haya que tomar" (Diario Digital 25-04-2012); (2) Rossi aseguró que votarán a favor de YPF unos doscientos diputados (La Nación 28-04-2012). Este hecho ha sido analizado por innumerables estudios y autores, muchos de los cuales se han aproximado a este tema desde la perspectiva variacionista que relaciona significados y contextos (Martínez 1987, Sedano 1994, Company 1999, Alaniz 2010); esta perspectiva explica dicha alternancia por medio de un continuum de factualidad el cual va desde la mayor factualidad de la perífrasis a la menor factualidad de la forma sintética. El análisis de los datos de acuerdo con dichos significados básicos postulados parecía confirmar la hipótesis, al menos en los contextos relacionados con la comunicación oral cotidiana (Martínez 1987). Sin embargo, un estudio más profundo sobre los usos de dichas formas en otros géneros discursivos (Mailhes 2010) nos lleva a replantearnos los significados básicos. En este sentido, la hipótesis que nos interesa confirmar es que las formas se encuentran vinculadas a la evaluación de los hechos por medio de la posibilidad de ejercer control sobre los mismos . Si existe control, se puede seleccionar la perífrasis; si no existe, la forma sintética será más apropiada. La ausencia de control puede dar lugar a una posibilidad más o menos remota así como a la profecía, dos esferas donde la variación es explotada

Back to the future to revisit meanings

Tanto en los estudios sincrónicos como en los diacrónicos queda en evidencia que el español posee diferentes formas de expresar el tiempo futuro. Por ejemplo, la desinencia del futuro morfológico (-ré) alterna en el español actual con la perífrasis verbal ir+a+infinitivo tal y como se ve en los siguientes ejemplos de la variedad rioplatense: (1) CFK advirtió que "Vamos a sostener este modelo de crecimiento con todas las decisiones que haya que tomar" (Diario Digital 25-04-2012); (2) Rossi aseguró que votarán a favor de YPF unos doscientos diputados (La Nación 28-04-2012). Este hecho ha sido analizado por innumerables estudios y autores, muchos de los cuales se han aproximado a este tema desde la perspectiva variacionista que relaciona significados y contextos (Martínez 1987, Sedano 1994, Company 1999, Alaniz 2010); esta perspectiva explica dicha alternancia por medio de un continuum de factualidad el cual va desde la mayor factualidad de la perífrasis a la menor factualidad de la forma sintética. El análisis de los datos de acuerdo con dichos significados básicos postulados parecía confirmar la hipótesis, al menos en los contextos relacionados con la comunicación oral cotidiana (Martínez 1987). Sin embargo, un estudio más profundo sobre los usos de dichas formas en otros géneros discursivos (Mailhes 2010) nos lleva a replantearnos los significados básicos. En este sentido, la hipótesis que nos interesa confirmar es que las formas se encuentran vinculadas a la evaluación de los hechos por medio de la posibilidad de ejercer control sobre los mismos . Si existe control, se puede seleccionar la perífrasis; si no existe, la forma sintética será más apropiada. La ausencia de control puede dar lugar a una posibilidad más o menos remota así como a la profecía, dos esferas donde la variación es explotada

Heat index at 2 m above ground: A globally gridded dataset based on reanalysis data from 1979-2013, links to GeoTIFFs

The increase in global mean temperatures resulting from climate change has wide reaching consequences for the earth's ecosystems and other natural systems. Many studies have been devoted to evaluating the distribution and effects of these changes. We go a step further and evaluate global changes to the heat index, a measure of temperature as perceived by humans. Heat index, which is computed from temperature and relative humidity, is more important than temperature for the health of humans and other animals. Even in cases where the heat index does not reach dangerous levels from a health perspective, it has been shown to be an important factor in worker productivity and thus in economic productivity. We compute heat index from dewpoint temperature and absolute temperature 2 m above ground from the ERA-Interim reanalysis dataset for the years 1979-2013. The data is provided aggregated to daily minima, means and maxima. Furthermore, the data is temporally aggregated to monthly and yearly values and spatially aggregated to the level of countries after being weighted by population density in order to demonstrate its usefulness for the analysis of its impact on human health and productivity. The resulting data deliver insights into the spatiotemporal development of near-ground heat index during the course of the past 3 decades. It is shown that the impact of changing heat index is unevenly distributed through space and time, affecting some areas differently than others. The likelihood of dangerous heat index events has increased globally. Also, heat index climate groups that would formerly be expected closer to the tropics have spread latitudinally to include areas closer to the poles. The data can serve in future studies as a basis for evaluating and understanding the evolution of heat index in the course of climate change, as well as its impact on human health and productivity.

Photochemical responses of the diatom Skeletonema costatum grown under elevated CO2 concentrations to short-term changes in pH

Variability in pH is a common occurrence in many aquatic environments, due to physical, chemical and biological processes. In coastal waters, lagoons, estuaries and inland waters, pH can change very rapidly (within seconds or hours) in addition to daily and seasonal changes. At the same time, progressive ocean acidification caused by anthropogenic CO2 emissions is superimposed on these spatial and temporal pH changes. Photosynthetic organisms are therefore unavoidably subject to significant pH variations at the cell surface. Whether this will affect their response to long-term ocean acidification is still unknown, nor is it known whether the short-term sensitivity to pH change is affected by the pCO2 to which the cells are acclimated. We posed the latter open question as our experimental hypothesis: Does acclimation to seawater acidification affect the response of phytoplankton to acute pH variations? The diatom Skeletonema costatum, commonly found in coastal and estuarine waters where short-term acute changes in pH frequently occur, was selected to test the hypothesis. Diatoms were grown at both 390 (pH 8.2, low CO2; LC) and 1000 (pH 7.9, high CO2; HC) µatm CO2 for at least 20 generations, and photosynthetic responses to short-term and acute changes in pH (between 8.2 and 7.6) were investigated. The effective quantum yield of LC-grown cells decreased by ca. 70% only when exposed to pH 7.6; this was not observed when exposed to pH 7.9 or 8.2. HC-grown cells did not show significant responses in any pH treatment. Non-photochemical quenching showed opposite trends. In general, our results indicate that while LC-grown cells are rather sensitive to acidification, HC-grown cells are relatively unresponsive in terms of photochemical performance.

Metodologías de modelado, monitorización y asistencia robótica en neurorrehabilitación funcional de extremidad superior

La Organización Mundial de la Salud (OMS) prevé que para el año 2020, el Daño Cerebral Adquirido (DCA) estará entre las 10 causas más comunes de discapacidad. Estas lesiones, dadas sus consecuencias físicas, sensoriales, cognitivas, emocionales y socioeconómicas, cambian dramáticamente la vida de los pacientes y sus familias. Las nuevas técnicas de intervención precoz y el desarrollo de la medicina intensiva en la atención al DCA han mejorado notablemente la probabilidad de supervivencia. Sin embargo, hoy por hoy, las lesiones cerebrales no tienen ningún tratamiento quirúrgico que tenga por objetivo restablecer la funcionalidad perdida, sino que las terapias rehabilitadoras se dirigen hacia la compensación de los déficits producidos. Uno de los objetivos principales de la neurorrehabilitación es, por tanto, dotar al paciente de la capacidad necesaria para ejecutar las Actividades de Vida Diaria (AVDs) necesarias para desarrollar una vida independiente, siendo fundamentales aquellas en las que la Extremidad Superior (ES) está directamente implicada, dada su gran importancia a la hora de la manipulación de objetos. Con la incorporación de nuevas soluciones tecnológicas al proceso de neurorrehabilitación se pretende alcanzar un nuevo paradigma centrado en ofrecer una práctica personalizada, monitorizada y ubicua con una valoración continua de la eficacia y de la eficiencia de los procedimientos y con capacidad de generar conocimientos que impulsen la ruptura del paradigma de actual. Los nuevos objetivos consistirán en minimizar el impacto de las enfermedades que afectan a la capacidad funcional de las personas, disminuir el tiempo de incapacidad y permitir una gestión más eficiente de los recursos. Estos objetivos clínicos, de gran impacto socio-económico, sólo pueden alcanzarse desde una apuesta decidida en nuevas tecnologías, metodologías y algoritmos capaces de ocasionar la ruptura tecnológica necesaria que permita superar las barreras que hasta el momento han impedido la penetración tecnológica en el campo de la rehabilitación de manera universal. De esta forma, los trabajos y resultados alcanzados en la Tesis son los siguientes: 1. Modelado de AVDs: como paso previo a la incorporación de ayudas tecnológicas al proceso rehabilitador, se hace necesaria una primera fase de modelado y formalización del conocimiento asociado a la ejecución de las actividades que se realizan como parte de la terapia. En particular, las tareas más complejas y a su vez con mayor repercusión terapéutica son las AVDs, cuya formalización permitirá disponer de modelos de movimiento sanos que actuarán de referencia para futuros desarrollos tecnológicos dirigidos a personas con DCA. Siguiendo una metodología basada en diagramas de estados UML se han modelado las AVDs 'servir agua de una jarra' y 'coger un botella' 2. Monitorización ubícua del movimiento de la ES: se ha diseñado, desarrollado y validado un sistema de adquisición de movimiento basado en tecnología inercial que mejora las limitaciones de los dispositivos comerciales actuales (coste muy elevado e incapacidad para trabajar en entornos no controlados); los altos coeficientes de correlación y los bajos niveles de error obtenidos en los corregistros llevados a cabo con el sistema comercial BTS SMART-D demuestran la alta precisión del sistema. También se ha realizado un trabajo de investigación exploratorio de un sistema de captura de movimiento de coste muy reducido basado en visión estereoscópica, habiéndose detectado los puntos clave donde se hace necesario incidir desde un punto de vista tecnológico para su incorporación en un entorno real 3. Resolución del Problema Cinemático Inverso (PCI): se ha diseñado, desarrollado y validado una solución al PCI cuando el manipulador se corresponde con una ES humana estudiándose 2 posibles alternativas, una basada en la utilización de un Perceptrón Multicapa (PMC) y otra basada en sistemas Artificial Neuro-Fuzzy Inference Systems (ANFIS). La validación, llevada a cabo utilizando información relativa a los modelos disponibles de AVDs, indica que una solución basada en un PMC con 3 neuronas en la capa de entrada, una capa oculta también de 3 neuronas y una capa de salida con tantas neuronas como Grados de Libertad (GdLs) tenga el modelo de la ES, proporciona resultados, tanto de precisión como de tiempo de cálculo, que la hacen idónea para trabajar en sistemas con requisitos de tiempo real 4. Control inteligente assisted-as-needed: se ha diseñado, desarrollado y validado un algoritmo de control assisted-as-needed para una ortesis robótica con capacidades de actuación anticipatoria de la que existe un prototipo implementado en la actualidad. Los resultados obtenidos demuestran cómo el sistema es capaz de adaptarse al perfil disfuncional del paciente activando la ayuda en instantes anteriores a la ocurrencia de movimientos incorrectos. Esta estrategia implica un aumento en la participación del paciente y, por tanto, en su actividad muscular, fomentándose los procesos la plasticidad cerebral responsables del reaprendizaje o readaptación motora 5. Simuladores robóticos para planificación: se propone la utilización de un simulador robótico assisted-as-needed como herramienta de planificación de sesiones de rehabilitación personalizadas y con un objetivo clínico marcado en las que interviene una ortesis robotizada. Los resultados obtenidos evidencian como, tras la ejecución de ciertos algoritmos sencillos, es posible seleccionar automáticamente una configuración para el algoritmo de control assisted-as-needed que consigue que la ortesis se adapte a los criterios establecidos desde un punto de vista clínico en función del paciente estudiado. Estos resultados invitan a profundizar en el desarrollo de algoritmos más avanzados de selección de parámetros a partir de baterías de simulaciones Estos trabajos han servido para corroborar las hipótesis de investigación planteadas al inicio de la misma, permitiendo, asimismo, la apertura de nuevas líneas de investigación. Summary The World Health Organization (WHO) predicts that by the year 2020, Acquired Brain Injury (ABI) will be among the ten most common ailments. These injuries dramatically change the life of the patients and their families due to their physical, sensory, cognitive, emotional and socio-economic consequences. New techniques of early intervention and the development of intensive ABI care have noticeably improved the survival rate. However, in spite of these advances, brain injuries still have no surgical or pharmacological treatment to re-establish the lost functions. Neurorehabilitation therapies address this problem by restoring, minimizing or compensating the functional alterations in a person disabled because of a nervous system injury. One of the main objectives of Neurorehabilitation is to provide patients with the capacity to perform specific Activities of the Daily Life (ADL) required for an independent life, especially those in which the Upper Limb (UL) is directly involved due to its great importance in manipulating objects within the patients' environment. The incorporation of new technological aids to the neurorehabilitation process tries to reach a new paradigm focused on offering a personalized, monitored and ubiquitous practise with continuous assessment of both the efficacy and the efficiency of the procedures and with the capacity of generating new knowledge. New targets will be to minimize the impact of the sicknesses affecting the functional capabilitiies of the subjects, to decrease the time of the physical handicap and to allow a more efficient resources handling. These targets, of a great socio-economic impact, can only be achieved by means of new technologies and algorithms able to provoke the technological break needed to beat the barriers that are stopping the universal penetration of the technology in the field of rehabilitation. In this way, this PhD Thesis has achieved the following results: 1. ADL Modeling: as a previous step to the incorporation of technological aids to the neurorehabilitation process, it is necessary a first modelling and formalization phase of the knowledge associated to the execution of the activities that are performed as a part of the therapy. In particular, the most complex and therapeutically relevant tasks are the ADLs, whose formalization will produce healthy motion models to be used as a reference for future technological developments. Following a methodology based on UML state-chart diagrams, the ADLs 'serving water from a jar' and 'picking up a bottle' have been modelled 2. Ubiquitous monitoring of the UL movement: it has been designed, developed and validated a motion acquisition system based on inertial technology that improves the limitations of the current devices (high monetary cost and inability of working within uncontrolled environments); the high correlation coefficients and the low error levels obtained throughout several co-registration sessions with the commercial sys- tem BTS SMART-D show the high precision of the system. Besides an exploration of a very low cost stereoscopic vision-based motion capture system has been carried out and the key points where it is necessary to insist from a technological point of view have been detected 3. Inverse Kinematics (IK) problem solving: a solution to the IK problem has been proposed for a manipulator that corresponds to a human UL. This solution has been faced by means of two different alternatives, one based on a Mulilayer Perceptron (MLP) and another based on Artificial Neuro-Fuzzy Inference Systems (ANFIS). The validation of these solutions, carried out using the information regarding the previously generated motion models, indicate that a MLP-based solution, with an architecture consisting in 3 neurons in the input layer, one hidden layer of 3 neurons and an output layer with as many neurons as the number of Degrees of Freedom (DoFs) that the UL model has, is the one that provides the best results both in terms of precission and in terms of processing time, making in idoneous to be integrated within a system with real time restrictions 4. Assisted-as-needed intelligent control: an assisted-as-needed control algorithm with anticipatory actuation capabilities has been designed, developed and validated for a robotic orthosis of which there is an already implemented prototype. Obtained results demonstrate that the control system is able to adapt to the dysfunctional profile of the patient by triggering the assistance right before an incorrect movement is going to take place. This strategy implies an increase in the participation of the patients and in his or her muscle activity, encouraging the neural plasticity processes in charge of the motor learning 5. Planification with a robotic simulator: in this work a robotic simulator is proposed as a planification tool for personalized rehabilitation sessions under a certain clinical criterium. Obtained results indicate that, after the execution of simple parameter selection algorithms, it is possible to automatically choose a specific configuration that makes the assisted-as-needed control algorithm to adapt both to the clinical criteria and to the patient. These results invite researchers to work in the development of more complex parameter selection algorithms departing from simulation batteries Obtained results have been useful to corroborate the hypotheses set out at the beginning of this PhD Thesis. Besides, they have allowed the creation of new research lines in all the studied application fields.

Certificados electrónicos de servidor en administración y comercio electrónicos: garantías de seguridad

El uso de Internet por parte de los ciudadanos para relacionarse con las Administraciones Públicas o en relación con actividades de comercio electrónico crece día a día. Así lo evidencian los diferentes estudios realizados en esta materia, como los que lleva a cabo el Observatorio Nacional de las Telecomunicaciones y la Sociedad de la Información (http://www.ontsi.red.es/ontsi/). Se hace necesario, por tanto, identificar a las partes intervinientes en estas transacciones, además de dotarlas de la confidencialidad necesaria y garantizar el no repudio. Uno de los elementos que, junto con los mecanismos criptográficos apropiados, proporcionan estos requisitos, son los certificados electrónicos de servidor web. Existen numerosas publicaciones dedicadas a analizar esos mecanismos criptográficos y numerosos estudios de seguridad relacionados con los algoritmos de cifrado, simétrico y asimétrico, y el tamaño de las claves criptográficas. Sin embargo, la seguridad relacionada con el uso de los protocolos de seguridad SSL/TLS está estrechamente ligada a dos aspectos menos conocidos:  el grado de seguridad con el que se emiten los certificados electrónicos de servidor que permiten implementar dichos protocolos; y  el uso que hacen las aplicaciones software, y en especial los navegadores web, de los campos que contiene el perfil de dichos certificados. Por tanto, diferentes perfiles de certificados electrónicos de servidor y diferentes niveles de seguridad asociados al procedimiento de emisión de los mismos, dan lugar a diferentes tipos de certificados electrónicos. Si además se considera el marco jurídico que afecta a cada uno de ellos, se puede concluir que existe una tipología de certificados de servidor, con diferentes grados de seguridad o de confianza. Adicionalmente, existen otros requisitos que también pueden pasar desapercibidos tanto a los titulares de los certificados como a los usuarios de los servicios de comercio electrónico y administración electrónica. Por ejemplo, el grado de confianza que otorgan los navegadores web a las Autoridades de Certificación emisoras de los certificados y cómo estas adquieren tal condición, o la posibilidad de poder verificar el estado de revocación del certificado electrónico. El presente trabajo analiza todos estos requisitos y establece, en función de los mismos, la correspondiente tipología de certificados electrónicos de servidor web. Concretamente, las características a analizar para cada tipo de certificado son las siguientes:  Seguridad jurídica.  Normas técnicas.  Garantías sobre la verdadera identidad del dominio.  Verificación del estado de revocación.  Requisitos del Prestador de Servicios de Certificación. Los tipos de certificados electrónicos a analizar son:  Certificados de servidor web:  Certificados autofirmados y certificados emitidos por un Prestador de Servicios de Certificación.  Certificados de dominio simple y certificados multidominio (wildcard y SAN)  Certificados de validación extendida.  Certificados de sede electrónica. ABSTRACT Internet use by citizens to interact with government or with e-commerce activities is growing daily. This topic is evidenced by different studies in this area, such as those undertaken by the Observatorio Nacional de las Telecomunicaciones y la Sociedad de la Información (http://www.ontsi.red.es/ontsi/ ). Therefore, it is necessary to identify the parties involved in these transactions, as well as provide guaranties such as confidentiality and non-repudiation. One instrument which, together with appropriate cryptographic mechanisms, provides these requirements is SSL electronic certificate. There are numerous publications devoted to analyzing these cryptographic mechanisms and many studies related security encryption algorithms, symmetric and asymmetric, and the size of the cryptographic keys. However, the safety related to the use of security protocols SSL / TLS is closely linked to two lesser known aspects:  the degree of security used in issuing the SSL electronic certificates; and  the way software applications, especially web Internet browsers, work with the fields of the SSL certificates profiles. Therefore, the diversity of profiles and security levels of issuing SSL electronic certificates give rise to different types of certificates. Besides, some of these electronic certificates are affected by a specific legal framework. Consequently, it can be concluded that there are different types of SSL certificates, with different degrees of security or trustworthiness. Additionally, there are other requirements that may go unnoticed both certificate holders and users of e-commerce services and e-Government. For example, the degree of trustworthiness of the Certification Authorities and how they acquire such a condition by suppliers of Internet browsers, or the possibility to verify the revocation status of the SSL electronic certificate. This paper discusses these requirements and sets, according to them, the type of SSL electronic certificates. Specifically, the characteristics analyzed for each type of certificate are the following:  Legal security.  Technical standards.  Guarantees to the real identity of the domain.  Check the revocation status.  Requirements of the Certification Services Providers. The types of electronic certificates to be analyzed are the following:  SSL electronic certificates:  Self-signed certificates and certificates issued by a Certification Service Provider.  Single-domain certificates and multi-domain certificates (wildcard and SAN)  Extended Validation Certificates.  “Sede electrónica” certificates (specific certificates for web sites of Spanish Public Administrations).

A knowledge based framework to support active aging at home based environments

Information and Communication Technologies can support Active Aging strategies in a scenario like the Smart Home. This paper details a person centered distributed framework, called TALISMAN+, whose aim is to promote personal autonomy by taking advantage of knowledge based technologies, sensors networks, mobile devices and internet. The proposed solution can support an elderly person to keep living alone at his house without being obliged to move to a residential center. The framework is composed by five subsystems: a reasoning module that is able to take local decisions at home in order to support active aging, a biomedical variables telemonitorisation platform running on a mobile device, a hybrid reasoning middleware aimed to assess cardiovascular risk in a remote way, a private vision based sensor subsystem, and a secure telematics solution that guarantees confidentiality for personal information. TALISMAN+ framework deployment is being evaluated at a real environment like the Accessible Digital Home.